Hematology-Oncology Clinics of North America最新文献

The CD30 antibody-drug conjugate, brentuximab vedotin, and PD-1 inhibitors, nivolumab and pembrolizumab have transformed the care of patients with Hodgkin lymphoma and have been incorporated into earlier lines of therapy. However, there are limited treatment options for patients with relapsed/refractory disease whose disease has progressed after brentuximab vedotin and checkpoint inhibitors. Novel immunotherapies for patients with relapsed/refractory Hodgkin lymphoma include CAR-T products, EBV-specific T cells, bispecific antibodies, and checkpoint inhibitor combinations. We review the rationale for each and summarize safety, efficacy, and progress in clinical development.

Despite continued advances, survival among patients with Hodgkin lymphoma differs by age, race and ethnicity, socioeconomic status, insurance, and treatment location. Inequities are evident across the cancer care continuum, from timely diagnosis and treatment initiation and clinical trial access, to posttreatment survivorship care. As the therapeutic landscape for Hodgkin lymphoma evolves, studies examining the impact of new treatments on disparities are needed to ensure that treatment advances benefit all populations equitably.

Hodgkin lymphoma is the most common hematologic malignancy diagnosed during pregnancy, attributed to overlapping peak incidence with the reproductive years. Management during pregnancy requires a multidisciplinary team including hematology/oncology, maternal fetal medicine, anesthesiology, and neonatology. Treatment is driven by gestational age and symptoms in accordance with the patient's wishes. Ultimately, the goal is to maximize the cure rate of the mother while allowing for term delivery of a healthy child. This article provides practical recommendations on staging and management of Hodgkin lymphoma in pregnancy, including the optimal choice and timing of therapy by gestational age, along with supportive care considerations.

Stem cell transplantation remains a cornerstone in managing relapsed/refractory classic Hodgkin lymphoma, though its role is evolving with the integration of targeted therapies. Autologous stem cell transplantation achieves cure rates of 50% to 60%, enhanced significantly with the introduction of novel agents including brentuximab vedotin and checkpoint inhibitor-based salvage and consolidation regimens. Allogeneic transplantation with reduced-intensity conditioning offers curative potential for patients with disease that relapses after autologous stem cell transplantation. This article reviews the evidence for autologous and allogeneic stem cell transplantation, their integration with novel agents, and the emerging transplant-sparing strategies.

The management of advanced-stage Hodgkin lymphoma has entered an era defined by immune-based therapy. Nivolumab-AVD has become the preferred frontline regimen, delivering high cure rates with minimal toxicity across age groups. BrECADD remains an effective, fertility-sparing option for select young, fit patients requiring intensification. As outcomes improve, traditional prognostic models and response assessment tools need reassessment. Survivorship principles now guide individualized care that balances efficacy with long-term health. Optimizing survivorship further requires continued efforts to identify both low-risk patients for therapy de-escalation and high-risk patients for alternative approaches.

Circulating tumor DNA (ctDNA) has emerged as a promising biomarker in classic Hodgkin lymphoma (cHL). Abundant ctDNA shedding from Hodgkin/Reed-Sternberg cells enables comprehensive molecular profiling directly from plasma. Recent studies have identified mutation- and copy-number-based molecular subtypes which now require harmonization across cohorts. Serial ctDNA monitoring at various landmarks, including end of treatment, allows sensitive detection of minimal residual disease and identifies patients at increased risk of relapse. Together, these data support ctDNA as a noninvasive tool that complements existing diagnostics and holds promise for more personalized, biology-guided treatment in cHL.

The treatment landscape of classical Hodgkin lymphoma continues to evolve with earlier use of novel agents. Most recently, the addition of PD-1 inhibitors into frontline therapy has improved cure rates but introduced new challenges at relapse. How prior exposure to these agents impacts disease biology and response to salvage regimens remains unclear, thereby complicating second-line treatment decisions. This review discusses current considerations for selecting a salvage therapy in the era of frontline novel agents.